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General NPI Number Information
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NPI Number | 1023318490
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Entity Type | Individual
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Provider Name | KIMBERLEE PHILLIPS COTA
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Gender | Female
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Dates
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Enumeration Date | 11/01/2010
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Last Update Date | 11/01/2010
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Provider Practice Location Address
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Address Line | 10 SANFORD ST
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City | GLENS FALLS
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State | NY
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Zip | 12801-2931
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Country | US
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Telephone | 518-793-5653
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Fax | 518-793-5770
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Provider Business Mailing Address
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Address Line | 15 QUADE ST
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City | GLENS FALLS
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State | NY
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Zip | 12801-2724
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Country | US
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Telephone | 518-792-1212
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Fax | 518-743-9057
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 005689
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License Number State | NY
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